Crisis Management

The Ebola panic in the U.S. has subsided, but don’t delay developing protocols.

What would happen if one of your residents contracted Ebola virus disease? First, public health officials would arrive on the site to take over the apartment unit. According to David Margulies, president of The Margulies Communications Group, a crisis management consultancy based in Dallas, this means the public officials legally take control of the apartment until a hazardous site clean-up team selected and hired by the state of Texas arrives to perform remediation. “Remember that you are not in control of this process and you should defer all questions to the lead public health agency” once an apartment experiences a confirmed case or cases, says Margulies.

Margulies is speaking from experience. He consulted for an apartment property that was one of three properties in Dallas affected by the Ebola crisis last fall. His team also worked with the hazmat crew that provided services to the property and with the City of Dallas as well as with Dallas County.

Apartment managers are most likely to be informed that a resident has tested positive for Ebola by a local government health office like the county health department, said Margulies in a memo outlining lessons learned. Margulies shared the memo with MHN and the Texas Apartment Association. “Ebola, or any other communicable disease, is a public health issue,” he adds.

Sources interviewed all emphasize that policies and procedures are still evolving, as Ebola is a very new disease. “The newness of Ebola as a threat in the U.S. presents unique challenges,” says Paula Cino, vice president, Construction, Development and Land Use Policy, at the National Multifamily Housing Council (NMHC). “Apartment firms must remain flexible and allow for the possibility of a quickly changing landscape given that Ebola protocols are still emerging and not yet well established in the U.S.”

Based on the information so far known, what should an apartment community do if it finds out that a resident has been diagnosed with Ebola? “The first and most important action it should take is to reach out to its local health department,” says Cino.

The local health department, she adds, will be able to provide the immediate steps to ensure the safety of the residents and employees. Second, the community needs to implement its emergency response plan immediately. “Communication with authorities, residents, on-site staff and other key internal stakeholders is critical. We’re encouraging all NMHC members to develop these protocols well in advance,” says Cino.

Communication with residents is fundamental in the event of an outbreak at a community, agrees Melanie French, executive vice president of Cortland Partners. “This illness so far has been determined to be passed through bodily fluids, not air,” and apartment managers need to reach out to residents to communicate what it knows, she says. Emails or text messages to residents are “an excellent means of providing accurate information in a timely manner,” agrees Margulies. “If you do not have these capabilities, utilize letters posted on apartment doors. Assume that anything you write will find its way to the news media.”

According to Margulies, “Your employees are your first line of communications with residents.” In the Dallas case, he adds, public health officials were willing to attend meetings with employees to answer their questions and address any concerns.

Complete evacuation of an apartment property may not be necessary. In the recent cases in Texas, the remediation took half a day on the property that Margulies’ client managed. “Based on our experience in Dallas, other than restrictions on residents in nearby apartments in the same building who were asked to be out of their apartments during the emergency remediation….no one else was denied access to their apartment,” notes Margulies. Property managers may wish to provide hotel rooms for residents in the affected buildings until the hazmat work is completed.

There is a distinction between a resident who has been diagnosed with Ebola versus one who has been exposed to Ebola, comments French. If the apartment property learns that a resident has been exposed though not diagnosed with the illness, it will contact the Center for Disease Control (CDC) or local health department, and proceed from there. On the other hand, if a resident has been diagnosed with the illness, then the authorities will also be informed, and the apartment company knows it will immediately need to activate the emergency policies and procedures.

If one resident has come down with the sickness, “We’ve spoken with the CDC and we were told that because Ebola is spread through bodily fluids, it may not be necessary to clear out the whole building,” says French. The virus can live for several hours on surfaces of doorknobs, countertops and other items. All common areas, such as the fitness center, need to be closed and decontaminated. The authorities will notify all people who have been exposed or who have come into contact with the sick person, and the CDC recommends they place themselves in quarantine.

There is also the question of public notification. “It has been our experience that the patient’s family is usually the one that releases the patient’s name after a brief time,” said Margulies. In any case, it is a best practice to defer to the appropriate health department in dealing with media inquiries, advises Margulies. Allow “public safety officials to take the lead in media relations. They are the experts. They are aware of laws governing patient confidentiality.” Public safety agencies, he notes, employ experts trained in media relations.

“You can expect that the news media will eventually arrive at your property if a resident has been identified as someone who tested positive for Ebola,” writes Margulies in his memo. “Even if they are not notified by a public health agency, other residents or anyone seeing public safety activity at the property is likely to call the news media.”

The Ebola panic in the U.S. has subsided for now, but who knows when the next outbreak may occur. As far as what apartment communities can do as advance preparation for possible outbreaks in future, formal protocols specifically for Ebola have not been developed, as the disease is still new—even to the scientific community. However, Ebola needs to be regarded as a highly deadly infectious disease.

Apartment companies such as Cortland Partners have already trained their staff regarding how to respond to blood-borne illnesses, as part of their training programs. The company also maintains infectious disease protective gear at its communities.

Education of Cortland Partners’ onsite staff members for response to Ebola is also consistent with training for diseases that are passed through bodily fluids, says French. Staff need to be educated as to how to protect themselves from those types of diseases and when it is necessary to wear protective gear. “Make sure the teams are trained in those protocols,” says French. Also, apartment managers should keep in constant contact with apartment management trade groups for updates on the issue, and hold talks with their insurance carriers, French advises.

Of course, infectious diseases are a perennial issue that is always pertinent to apartment communities. Some of the fundamental preventative procedures apartment companies follow can be as simple as hand-washing. “Public health authorities stress the effectiveness of promoting basic hygiene and health practices, like hand washing and vaccination,” says NMHC’s Cino. Developing procedures now to keep staff at home if they are sick is also important to prevent further spread of disease in the event of an outbreak. Cino recommends workplace policies that detail sick-employee policies, telework options and business continuity procedures. These practices “can deter the progression of infectious disease events,” she adds.

“It’s a best practice to make sure that your employees are following procedures to protect themselves from contact with any type of virus or disease that could be prevalent at any time,” says Margulies. A desirable protocol, he adds, is to use bleach to clean public spaces such as laundry rooms, and especially exercise equipment in fitness centers. Sanitizers should be available in exercise rooms so that residents can clean the equipment before and after use.
Ultimately, says Cino, it is “critical to develop and maintain relationships with local health and safety officials” as events and existing precautionary recommendations can change rapidly.

Cases of Ebola
Diagnosed in the U.S.
Sept. 30, 2014—Texas
CDC confirmed the first laboratory-confirmed case of Ebola to be diagnosed in the U.S. in a man who had traveled to Dallas, Texas from Liberia. The patient passed away on Oct 8. By Nov. 7, all contacts of the patient completed the 21-day monitoring period.
Oct. 10, 2014—Texas
A healthcare worker at Texas Presbyterian Hospital who provided care for the patient tested positive for Ebola. The patient has since recovered and was discharged on Oct. 24.
Oct. 15, 2014—Texas
A second healthcare worker who provided care for the index patient at Texas Presbyterian Hospital tested positive for Ebola. The patient has since recovered and was discharged on Oct. 28. By Nov. 3, all passengers on the same two flights as the patient completed the 21-day monitoring period.
Oct. 23, 2014—New York
The New York City Department of Health and Mental Hygiene reported a case of Ebola in a medical aid worker who had returned to New York City from Guinea, where the medical aid worker had served with Doctors Without Borders. The patient has recovered and was discharged from Bellevue Hospital Center on Nov. 11.
Source: Centers for Disease Control and Prevention

Federal Resources
■ CDC Ebola Web Site
■ State and Local Health Departments
■ OSHA Fact Sheet—Decontamination of Ebola
on Surfaces
■ OSHA Ebola Resources
■ Ebola Prevention Resources
■ Ebola Communications Resources
■ National Institutes of Health Ebola Resources
■ U.S. Department of Labor
■ WHO FAQs on Ebola
■ WHO Information Resources on Ebola
■ Federal Flyers: Could it be Ebola? and
Algorithm for Evaluation of the Returned Traveler
Source: National Multifamily Housing Council